Travel and Relocation Health Assessment Form Form Template

Assess the health of employees before travel or relocation for work purposes.

Full Name *

Date of Birth *

Position/Job Title *

Planned Travel/Relocation Destination *

Expected Date of Departure *

Expected Duration of Stay *

Have you traveled internationally in the past year? *

If yes, please list the countries visited

Do you have any existing health conditions that could be affected by travel? *

If yes, please describe the conditions

Have you received all necessary immunizations for the destination? *

Do you require any special medications or treatments during travel?

Any known allergies (e.g., food, medication, environmental)?

Additional health concerns or considerations for travel/relocation

Signature of Employee *

Date of Submission *